A recent post from Isis the Scientist reminds us of that which we are all too able to ignore in this era of Highly Active Anti-Retroviral Therapy (HAART). HIV/AIDS may be slightly more controllable now. Infected individuals may be living much longer and with higher quality of life. Especially in the developed world regions from which much of this blog's traffic derives. We have become somewhat complacent in comparison with my memory of the first stages of what has been termed the HIV/AIDS pandemic.
Make no mistake. People are still dying prematurely. Dying because the scientific and medical efforts have been only partially successful and have yet to find a cure or preventative vaccine. People who are wonderful, helpful, joy-inducing, productive and loved members of our workplaces and families. Isis' post laments the passing of an individual who was a close and valued colleague.
Isis' post wonders if we have lost steam in our efforts to find cures or vaccines for AIDS.

As with no doubt many of you, I read the latest failures of large-scale vaccine studies with disappointment. It does seem at times as though drug therapy has also reached another plateau from which additional progress seems uncertain. (Although as someone who was at least somewhat aware of this health crisis from the no-therapy to the advent of AZT and then through modern cocktail HAART approaches, I appreciate that this is a lofty plateau indeed.) And people are still dying.
I am very far from an expert in the area and I have no answers for her. [I'll just note that Respectful Insolence and Aetiology are places to seek public-health side blogging on HIV/AIDS and of course ERV is the place for retrovirus biology] I do not know if research on HIV and AIDS has slackened although I suspect not. I have some colleagues working on infections disease and it seems that interest and NIH funding is still quite high. I've noted that the annual address by the Director of NIDA to the College on Problems of Drug Dependence frequently mentions the Congressional mandate to spend large fraction of the NIDA budget on HIV/AIDS research. There are other ICs with similar obligations. Not unexpectedly there is even a bit of water-cooler muttering about the relative balance of funding on AIDS in these tight times. I tend to conclude that it is not the research effort or interest that is the problem but rather that this is a really intractable problem.
Isis' post also triggered some additional thoughts on animal research which is the main point of the day.
Much of our understanding of the function of the very tricky and evasive Human Immunodeficiency
Virus was derived from animal research. This should not be surprising. And my point is not to rah-rah about which particular successes depended on which particular study.
Rather it is to make the assertion that this is one of the areas in which study of three of the more controversial laboratory species has been essential. Well, two really. The chimpanzee model has been important but has not been much of a player for the simple reason that there is, comparatively speaking, very, very little research on chimpanzee, period. This leaves the macaque monkey (simian immunodeficiency virus; SIV) and the cat (feline immunodeficiency virus; FIV). For those that are interested, by all means trod on over to PubMed and search for SIV or FIV and start reviewing the wealth of literature. Otherwise, for the main purpose here, just take my assertion that FIV and SIV investigations have been very big users of monkeys and cats in research in the past 15-20 years. There have been lots of vaccine trials, drug tests and basic virological/immunological research studies ongoing which have, if you add up the numbers, been VERY substantial users of the respective species compared to other research domains to which these species contribute.
It is rare to hear complaints about these uses, even from pretty extreme anti-animal research voices. Vanishingly rare. Rare even when minor flareups of ARA activity erupt.
Why is this? And where are you on this, Dear Reader?
Is it because AIDS scares or seems more salient to those who tend to oppose animal research? Is it a logical calculus of what is to be gained by additional research? The rather dramatic changes within recent memory of the prospects of the HIV infected individual before AZT came into use and after HAART was developed?
Is the use of the more charismatic laboratory species somehow better justified when it is for HIV/AIDS research? If so, how does that work?

My dearest DM,
Thank you for bringing attention to this problem by talking about it in your much more popular and highly-read blog. I truly hope that the scientific community will continue to advocate for advancement in this field. But, I think the source of yesterday's frustration was not with the realm of scientific development but with public health policy. You see, yours truly was a young woman in the AIDS-era (ie, the 90's) and remembers talk about safe sex and getting tested. And I remember the long and painful deaths of people pre-AZT. These images and messages seem to have gone away. I was only reminded of these messages myself when my dear former colleague died of a disease he had no idea he carried and yet, with the therapies you discuss, could have lived with for some time. Died of a disease perhaps he didn't give a second thought to. These events made me realize that there is a new generation of young people who do not recognize HIV as an issue and that truly frightens me. This issue frightens me both as a scientist and as a mother. I couldn't help but think to myself that last week one of my children learned "green." Last week my friend's mother buried her one of her children. To have to bury your child because they contract a preventable disease is a travesty.
I hope that we will continue to make therapeutic advancements in the medical and scientific domains. I hope that we will do so with the responsible use of both in vitro and in vivo models. And I especially hope that we will begin to educate our young people that HIV remains a concern, that it remains a fatal disease that will alter the course of their lives if they contract it, and that it is something they need to take steps to protect themselves from.
Kindest Regards,
Dr. Isis

On the animal research aspect, I think it is interesting to search PubMed for "feline immunodeficiency virus" and "simian immunodeficiency virus". In total, those searches produced ~7000 hits. In contrast (cancer[MeSH Term] limit: Animals) produces ~33,000 hits.
I think, on a per animal basis, FIV and SIV resarch gets us a lot closer to treatments/vaccines/cures than cancer research.
(not that "cancer" is a single disease, or that we haven't made some incredibly impressive advances on it, but I'm not sure those points are salient for random person who happens to care about animal rights)

I would add that rodents have been successfully used in the effort to understand the consequences of HIV exposure, both systemically as well as in the central nervous system. An advantage with these models is that they have actually used the HIV virus or HIV proteins in the studies. Having participated in some of this research I can say that issues related to finding a cure or at least better treatments are complex and difficult and will take time. HIV is a moving target, constantly evolving and evading the latest drug therapy. It also is good at hiding in the body making it almost impossible to eradicate.
Animal research of all types will be critical to any future success fighting the HIV/AIDS pandemic.
Finally, there is a big push by NIAAA and probably NIDA to spend money on HIV/AIDS and alcohol/drug abuse interactions since the clinical literature suggests that co-morbid drug abuse worsens the progression of HIV/AIDS. If you are so inclined, go after that money and help combat the disease!

http://www.nytimes.com/2008/09/12/science/12HIV.html?ref=science
56,000 new infections in the US in 2006
African-Americans, 15 % of the general population account for 45% of new cases. I think it was Field that said, we need to talk about the down-low people.
27% of new infections are female, 80% of those cases due to high-risk heterosexual contact.
80% of gay and bisexual men in 15 cities evaluated were not being reached by intense HIV prevention efforts.
/sigh

Is it because AIDS scares or seems more salient to those who tend to oppose animal research? Is it a logical calculus of what is to be gained by additional research? The rather dramatic changes within recent memory of the prospects of the HIV infected individual before AZT came into use and after HAART was developed?
I don't see where those aren't three different statements of the same completely reasonable point. The marginal utility of an animal study on a barely-understood, incurable, apocalyptic disease is far higher than for some incremental advance in a mature field, let alone for all the PZ Myerses out there doing animal studies to no meaningful end at all. Even if people oppose all animal work, it's not unreasonable for them to pick their battles.Isis' post wonders if we have lost steam in our efforts to find cures or vaccines for AIDS.
A lot of that is due to the fact that patent and pricing controversies have pushed many companies out of new HIV projects. At this point, unless they're willing to treat it as a goodwill writeoff, a successful new therapy is a liability to whoever comes up with it. Maybe 20 years ago, when pharmas were flush with money, there was low-hanging fruit to be picked and patients were eager to enroll in trials, that would have flown, but not today.
And, believe or not, pharma executives may wear $3000 suits, but they resent being called murderers just as much as you or I would. A lot of good will was evaporated in the 90's.